- Pain during ovulation
- Pain during sexual intercourse
- Painful periods
- Heavy prolonged or irregular bleeding
- Spotting before or after periods
- Difficulty in conceiving (sub-fertility)
If patches of endometriosis are present in other parts of the body, other symptoms or signs may be present. For example there may be blood in the urine and also pain on passing urine if endometriosis is situated in the bladder. There may be bleeding from the rectum and pain on defecation if the bowel is affected. Endometriotic nodules may form in the skin or in surgical scars and present as painful lumps. Occasionally patients may present with coughing up blood if endometriosis is present in the lungs. Most of these problems occur on a cyclical basis at the time of the menstrual period.
Endometriosis can be treated in a variety of ways but the majority of cases can be treated at the time of diagnosis by keyhole surgery. Other treatments may also be used in conjunction with surgery.
Combined oral contraceptive pill – taken continuously for six to nine months to prevent menstrual bleeding.
Progesterone therapy taken for six to nine months continuously to stop menstrual periods.
GNRH analogues – these drugs can be taken as a nasal spray or a monthly or three monthly injection to create a temporary “menopause”.Surgical Treatment
This is the most effective form of treatment. Surgical treatment of endometriosis is usually performed by laparoscopy (keyhole surgery). Superficial patches of endometriosis on the peritoneum may be treated with diathermy or be excised. Where there are deep nodules of endometriosis, surgery is more extensive and may involve excision of small parts of the bowel. Where fertility is no longer required and in severe debilitating cases, hysterectomy and oophorectomy (removal of the womb and ovaries) may be necessary. When there is advanced disease open surgery may be required. The incidence of complications from surgery is very low. However injuries to adjacent organs such as the bowel, bladder and ureters can occur.